Continuous improvement in quality and productivity processes is essential for any business that wants to be profitable but more so for Health care organizations due to the constant changing nature of their practice. The philosophy of continuous improvement is captured in the plan-do-check-act (PDCA) cycle proposed by W. Edwards Deming (Fitzsimmons et. Al. , 2013). The three principles that form the foundation for Deming’s teaching are Customer satisfaction, Management by Facts, and Respect for people.
Health care delivery must focus on satisfying patients’ needs and this principle must be incorporated into the mind of every employee of a healthcare organization. Scientific thinking (collecting and statistically analyzing data) must also be merged with administrative analysis before decisions are made by the quality improvement teams. For quality improvement to be established in an organization, there must be mutual respect amongst employees where everybody’s ideas on improving processes are solicited. By implementing these principles, the idea of “higher quality could lead to lower cost,” can be manifested.
How well is Intermountain Health Care performing? From the case study, intermountain Health care is performing very well. As of 2001, the intermountain healthcare (IHC) Health plan was the largest in Utah which covered about 460,000 individuals and a market share of 40%. The closest competitor being Blue Cross and Blue Shield, covered 425,000 individuals. IHC started with fifteen hospitals in 1975 and after 27 years grew it to 22 hospitals, 25 health centers and over 70 outpatient’s clinics all across Utah and Southeastern Idaho.
IHC is a vertically integrated Health care organization that has won many top awards in the industry. In 2000, 2002, 2003, 2004 and 2005, Intermountain Healthcare was ranked No. 1 (among nearly 600 evaluated) integrated healthcare systems in the U. S. by Modern Healthcare magazine and the Verispan research firm. The rankings measured efficiency, communication cost and quality of care. As of 2013, Intermountain Healthcare is internationally recognized, has a nonprofit system of 22 hospitals, a Medical Group with more than 185 physician clinics, and an affiliated health insurance company, SelectHealth.
It currently has 33,000 employees serving patients and plan members in Utah and Southeastern Idaho. Below is a list of other awards that IHC has received as a system: Hospitals & Health Networks recognized Intermountain Healthcare as one of “Health Care’s Most Wired 2013” in the nation. This was the fourteenth year Intermountain has been listed. Forbes magazine named Intermountain Healthcare to its list of “21 Most Admired Companies Making IT a Competitive Advantage” in 2013.
American College of Medical Quality gave the “Institutional Quality Leadership Award” to Intermountain Healthcare, the sole recipient of this award in 2013, for Intermountain longstanding commitment to clinical quality programs and innovations in healthcare delivery. The Gallup Organization again presented Intermountain Healthcare with its Great Workplace Award for 2013 Intermountain Healthcare ranked No. 3 overall in the U. S. and No. 1 in the western U. S. on the 2012 list of the nation’s Top 100 Integrated Health Systems compiled by IMS Health and Modern Healthcare magazine.
National Research Corporation presented a 2012/2013 Consumer Choice Award to Intermountain Healthcare for its hospitals, clinics, and business units’ having been selected by locally served consumers as having the best quality and image. What is Intermountain’s approach to the management of health care delivery? Intermountain uses Clinical integration as its approach to healthcare delivery. This involves both an organizational restructuring as well as the use of different set of tools (mainly technological tools).
With this approach of healthcare delivery, both the administrative and medical staff (physicians, nurses and pharmacist) collaborate to implement the perfect system of gathering, storing, and making accessible medical data on each patient. Analyzing this data gathered enables the medical team to create protocols or use decision support tools that focus on improving medical intervention for each patient as well as removing inefficiencies from their service process. Its core aim was to establish quality and extend full management accountability to IHC’s Clinical Function.
IHC health services was divided into four areas: Clinical conditions, clinical support services, service quality and administrative support processes. IHC also uses Deming’s PDCA Cycle and Lean Service to ensure continuous quality improvement. Why does Intermountain do it this way? Intermountain tries to continually improve its Quality improvement process by adopting the PDCA cycle. They plan by selecting “clinical problems” for Hospital based procedures. These processes are documented and data collected. By the top managers brainstorming, they are able to reach the root causes of the problems.
The “Do” in the PDCA cycle is used to implement solutions or processes to solve the Clinical problems on a Trail basis. (The implementation process is monitored and documented). The Check in the PDCA cycle is used to review and evaluate the outcomes of implementing the solution. The Act in the PDCA cycle helps the company to reflect and act on the learning experience. The changes in the processes that were successful are standardized and communicated to the employees. IHC also uses a Biannual advanced Training program in Health care Delivery Improvement (ATP) to come out with best practice protocols.
Here, they use the lean dimension ‘empowering those who do the work in continuous improvement’ or ‘human development’ which is a very important part of the lean process. Since the ideas are generated by the employees themselves, there is a lot of motivation to implement it. Why don’t all heath care delivery organizations do this? The implementation of information technology systems like Health evaluation through Logical processing system (HELP) and Electronic medical (EMR) are very expensive. The cost of training the staff and maintenance of these systems can be very expensive.
Some health care delivery organizations also see the clinical integration system as a loss of traditional physician autonomy, prestige, power and income. Some health care organizations also enjoy having inefficiencies in their systems so that they can exploit unsuspecting patients. We go to the hospital now and are requested to do all kinds of unnecessary lab tests, just to increase our medical bills. Conclusion Intermountain has adopted the strategy of improving continuously by adopting the PDCA cycle and it seems to be working for them since they are the largest Healthcare providers in Utah and Southeastern Idaho.
Its clinical integration approach to delivering care has resulted in the company winning numerous awards. The incorporation of information technology plays a crucial role in the quality improvement of their services. The incorporation of Deming’s idea that “Higher quality could lead to lower cost,” has given the IHC Health plan a competitive edge over other insurers in Utah. References Fitzsimmons, J. A. , Fitzsimmons, M. J. , & Bordoloi, S. K. (2014). Service Management Operations, Strategy, Information Technology. New York, NY: McGraw-Hill/Irwin. http://en. wikipedia.
org/wiki/Intermountain_Healthcare http://intermountainhealthcare. org/about/overview/awards/Pages/home. aspx http://www. beckershospitalreview. com/strategic-planning/back-to-basics-understanding-the-5-performance-dimensions-of-lean-in-healthcare. html Bohmer, R. M. J. , Edmondson, A. C. , & Feldman, L. R. (2013). Intermountain Health Care. Boston, MA: Harvard Business School Publication Roger, R. (2008). Commentary: Intermountain Healthcare. High Performing Healthcare Systems: Delivering Quality by Design. 179-184. Retrieved from http://www. longwoods. com/content/20147